Coconut oil is ~55% MCT's which includes chain lengths up to 12C. Less than 10% "MCT's" that you find in MCT oil which is mostly capric and caprylic acids (6 & 8C). Sorry, this is from memory, so the exact #'s may be off.
CO contains lauric acid that may be responsible for antimicrobial effects, etc. The shorter the chain length the more ketogenic an MCT will be. It is my understanding that the some of the longer chain MCT's are incorporated into chylomicrons. The shorter chain fatty acids are not and are processed in the liver.
both MCTs and coconut oil have their own unique "health benefits." If you want weight loss, for instance, go with MCT. If you want an antimicrobial effect and/or think tons of saturated fat is good for you, then eat coconut oil. However, it is just oil, and provides zero nutrition, so should be used sparingly regardless.
The answer is, it depends on your goals and where you want to use it. Coconut oil can be cooked with. My recollection is MCT oil should not. Coconut oil adds flavor, MCT does not.
As mentioned, MCT oil is a more "refined" source of MCT's. More so than coconut oil. So it will create more ketones and provide a more ready source of energy. But MCT's and coconut oil both come from plants (there's no change there). MCT's can come from coconut oil.
They use MCT oil for the epileptic diets, not so much coconut oil.